Appendixes_Rev_6_June_13.doc

AMENDMENT 1

GENERAL CONTRACTOR’S STATEMENT OF QUALIFICATIONS

APPENDICES

PART 1

1. ORGANIZATION

Name:

Address____________________________________________________________________

Principal Office______________________________________________________________

[ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Joint Venture

[ ] Other ________________________________________________________________ a.

How many years has your organization been in business as a Contractor? _________ b.

How many years has your organization been in business under its present business name? ________

c. Under what other or former names has your organization operated? _____________

2. EXPERIENCE

Complete Appendix A for each project listed below. List no more than five (5) projects.

Project 1 Name: _____________________________________________________

Project 2 Name: _____________________________________________________

Project 3 Name: _____________________________________________________

Project 4 Name: _____________________________________________________

Project 5 Name: _____________________________________________________

3. CAPACITY AND CAPABILITY TO PERFORM THE WORK

a. Total number of current employees:

Project Managers __________

Estimators

Superintendents

Foremen

Tradesmen

Administration

Others

b. Does your firm have the immediate capacity to perform the work required for this contract?

[ ] Yes [ ] No (Explain in Appendix M)

4. KEY PERSONNEL EXPERIENCE

Please note that more consideration will be given to those meeting or exceeding the required qualifications stated below.

Does your assigned Project Manager have the following minimum qualifications and experience? (Attach Resume in format shown at Appendix C)

(1) At least ten (10) years experience in the construction industry?

[ ] Yes Number Years: __________ [ ] No

(2) Experience on at least one (1) construction type as identified in 3a?

[ ] Yes Number Projects: _________

(3) Experience as a Project Manager on one (1) or more construction projects valued at $1,000,000 or more?

b.

Does your assigned Project Superintendent have the following minimum qualifications and experience? (Attach Resume in format shown at Appendix C)

At least ten (10) years experience in the construction industry?

Experience on at least one (1) construction type as identified in 3a?

(3) Experience as a Project Superintendent on one (1) or more construction projects valued at $1,000,000 or more?

c.

Does your assigned Safety Program Manager have the following minimum qualifications and experience? (Attach Resume in format shown at Appendix C)

At least five (5) years experience in a safety management role?

Experience on at least one (1) construction type as identified in 2a?

d.

List the individuals your firm will assign as your project management team, and the roles/functions each individual will perform during the construction/occupancy phase.

Project Manager: __________________________ Years with your firm: _____

Present Position/Job Title: ___________________ Years in this Position: _____

List other project(s) this person has had a similar role for the past ten (10) years.

Is your Project Manager a Principal or Officer of the firm? [ ] Yes [ ] No

Superintendent: ___________________________ Years with your firm: ______

Is your Superintendent a Principal or Officer of the firm? [ ] Yes [ ] No

(3) Safety Manager: __________________________ Years with your firm: ______

Is your Safety Manager a Principal or Officer of the firm? [ ] Yes [ ] No

(4) QA/QC Manager: _________________________ Years with your firm: ______

Is your QA/QC Manager a Principal or Officer of the firm? [ ] Yes [ ] No

e. Please include a wire organizational diagram (Appendix D) of the management team that will be assigned to this project. Identify relationships, duties and responsibilities and key roles of each individual.

5. SURETY

a.

Firm’s current surety company: _____________________________________________

Will this surety be used for the construction contract for this project?

[ ] Yes [ ] No (Explain in Appendix M)

Contact Agent: Name: _________________________ Telephone: _________________

Years utilizing this surety: _______________ Maximum Capacity: ________________

Aggregate Total of current surety in force: _______________

Is your firm free of having any construction contracts taken over by a surety for completion in the past seven (7) years?

Has your firm used other surety companies since 2008? [ ] Yes (list) [ ] No

Surety company

Contact

Surety company

Contact

6. SAFETY

Does your firm have a written safety program compliant with current Federal regulations? Provide a narrative of your firm’s written Safety Program at Appendix G.

Provide a list of key safety personnel, including the designated safety manager who will be assigned to this project, and list specific duties.

Name and Title

Specific Duties

Submit a letter from your insurance carrier listing your company’s Workmen’s Compensation Experience Modification Rate (EMR) for the most recent three-year policy period average. Include as APPENDIX H. Additionally provide the EMR for the past seven (7) years below:

2011_____ / 2010_____ / 2009_____ / 2008_____ / 2007_____/ 2006_____/ 2005_____

d. Provide the OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate for the three previous complete, calendar years 2009, 2010, and 2011, as defined by the U.S. Department of Labor, Occupational Safety and Health Administration.

2011_______________ / 2010_______________ / 2009_________________

e. Is your firm free of committing serious or willful violations of federal or state safety laws as determined by a final non-appealable decision of a court or government agency?

7.

INSURANCE & CLAIMS HISTORY

a. Is your firm free from any court judgments, pending litigation, arbitration and final agency decisions filed within the last seven (7) years in a construction related matter in which the contractor, or any officer, is or was party?

b. Has your firm during the past seven (7) years been free of a determination by a court of competent jurisdiction that it filed a false claim with any federal, state, or local government entity?

Does your firm have the ability to provide the required insurance (General Liability and Comprehensive Auto at $1M per occurrence and $5M in the aggregate)?

Please provide a letter from an insurance carrier stating that the firm is able to obtain insurance in the limits stated as Appendix H.

8. QUALITY ASSURANCE

Does your firm have a written Quality Assurance Program?

b.

Provide one (1) copy of the written Assurance Program (Appendix I).

9. PROJECT SCHEDULING

a.

Does your firm use computerized scheduling? [ ] Yes [ ] No

If yes, which programs and versions are used? Please list.

c. Has the firm been involved with a construction project within the past seven (7) years, where the schedule was not met?

If yes, please indicate the projects (refer to Appendix A).

Project: ________________________________________________________

Reason for Delay: ________________________________________________

(3)

e. Has the firm been assessed liquidated damages due to scheduling for any project in the past seven (7) years? (Refer to Appendix A) f.

If Yes, List Projects

10.

LABOR CODE VIOLATIONS

Has your firm, during the past seven (7) years, been free of any determinations by a court or an administrative agency of repeated or willful violations of laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices of public works projects?

b. Is the firm free of all Sub-contractor Fair Practices Act violations for the past seven (7) years?

11.

GENERAL CONTRACTOR’S COMMENTS

Please provide further explanation of items indicated requiring explanation, or other additional information to further explain any of the questions asked in this Qualification Statement (Appendix M).

Additional information provided as outlined in the Request for Proposal (written qualification limitation of 10 pages) will be attached as Appendix N.

The undersigned certifies that all of the Qualification information submitted with this form to the best of their knowledge is true and correct.

Firm Name

Signature

Address of Firm

E-mail Address

City, State, Zip Code

Telephone

Respondents are reminded to include a copy of each requested Team Member’s Statement of Qualifications with this Qualification Document.

APPENDICES INCLUDED:

(Please check all appendices included in this Submittal)

A Project Experience of Similar Complexity and Scope

B Project Narrative C Resumes of Key Project Personnel

D Project Management Wire Diagram

E

NOT USED

F

NOT USED

G Safety Narrative H Letter(s) From Insurance Carrier(s) for EMR and Ability to Insure

[ ] I Copy of Assurance Program

J

NOT USED

K

NOT USED

[ ] L Management Plan

M Clarifications, and Explanations

[ ] N Additional Information (Optional)

APPENDIX A

COMPLETE ONE FORM FOR EACH PROJECT LISTED ON THE QUESTIONNAIRE

PROJECT DESCRIPTION

Project Type: ______________________________ Contact Title:

Project Name: _________________

Contact Name:

Owner:

Contact Phone No:

DESIGN PROFESSIONAL

Phone Number:

Contact:

Title:

Gross Building Area (Sq Ft):

[ ] New [ ] Addition [ ] Renovation

Project Start Date:

Completion Date:

Original Contract Amount: $

Original Contract Duration (days)

Final Contract Amount

Final Contract Duration (days)

With all Change Orders: $

With All Time Extensions:

PROJECT EXECUTION

Were Liquidated Damages Assed on this Project? [ ] No [ ] Yes days _____ $

Percentage of Work Subcontracted: _______________% Contract Type: [ ] Competitive Bid Lump Sum

[ ] Negotiated Lump Sum

Major Subcontractors: [ ] Guaranteed Maximum Price

[ ] Design/Build [ ] Other (Describe)

Mechanical

Electrical

Plumbing

LEED certification level ________________

Concrete

Fire

Protection

Awards, commendations, received:

APPENDIX B

Project Narrative

APPENDIX C

REFERENCE: 4.d.(1, 2, 3, 4 ) Resumes

ATTACH ONE (1) PAGE RESUMES OF THE PROPOSED

PROJECT MANAGER

PROJECT SUPERINTENDENT

SAFETY PROGRAM MANAGER

QA/QC MANAGER

OTHER KEY PERSONNEL (OPTIONAL)

1.0 EDUCATION

College, Trade Schools, Trade Seminars, Trade/Management Specialized Courses, etc.

2.0 RELATED EXPERIENCE

Related experience should include the Position Title, Duties and Responsibilities, Major Accomplishments, and Number of Personnel Supervised.

3.0 PROJECT EXPERIENCE

Identify project experience. Include the Project Title and Location.

4.0 Other information that demonstrates the individual’s strengths for this project.

5.0 Project Professionals and Project Owner Reference may be included.

APPENDIX D

REFERENCE: Wire Diagram of Project Management Structure.

1. Indicate the relationship between the PM/Supt of the Subcontractors and the GC PM/SUPT.

2. Indicate the relationship of the Safety Manager of the Subcontractors and GC, and the relationship of the Safety Manager with others on the job site.

3. Indicate the relationship between the QA/QC manager(s) with other personnel on the job site.

APPENDIX E

NOT USED

APPENDIX F

NOT USED

APPENDIX G

REFERENCE: Copy of Firm’s written Safety Narrative.

APPENDIX H

REFERENCE: Letter(s) from Insurance Carrier(s) .

ON LETTERHEAD OF INSURANCE CARRIER ORGANIZATION

APPENDIX I

REFERENCE: Written Assurance Program Narrative.

APPENDIX J

NOT USED

APPENDIX K

NOT USED

APPENDIX L

REFERENCE: Management Plan

APPENDIX M

REFERENCE: Clarifications/Explanations Additional written explanations or comments required for clarification of items contained in the Statement of Qualifications.

ITEM REF

NUMBER

COMMENTS

APPENDIX N

REFERENCE: Additional Information

Additional written qualifications (optional) are limited to a maximum of ten (10) pages of text/photos, single sided, excluding a single cover letter, title page, table of contents, dividers and covers. Material should be limited to 8-1/2” x 11” format.

PART 2

1. ORGANIZATION

Address_______________________________________________________________

Principal Office_________________________________________________________________

[ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Joint Venture

[ ] Other ____________________________________________________________

How many years has your organization been in business as a firm? ______

How many years has your organization been in business under its present business name? ________

d. Under what other or former names has your organization operated? _____________

Name and Licensure of the Architect/Engineer of Record

Issue Date: _____________________ Expiration Date: _____________________

2. DESIGN TEAM

Identify the names and addresses of consulting firms proposed for your design team.

Architect(s)

Structural Engineer(s)

Mechanical Engineer(s)

Electrical Engineer(s)

Civil Engineer(s)

Space Planner(s)

Audio Visual Consultant(s)

Kitchen Consultant(s)

Other(s)

ATTACH ADDITIONAL SHEETS AS REQUIRED

3. EXPERIENCE

Complete Appendix A for three (3) maximum projects listed.

Project 1 Name: _____________________________________________________

Project 2 Name: _____________________________________________________

Project 3 Name: _____________________________________________________

4. KEY PERSONNEL EXPERIENCE

Key staff proposed by the Offeror to be assigned to the project under this RFP should be the same Offeror’s staff utilized in similar roles for example projects included in the response. Please note that more consideration will be given to those meeting or exceeding the required qualifications stated below.

Does the assigned Architect have the following minimum qualifications and experience? (Attach Resume in format shown at Appendix B)

Architect of Record on at least two (2) projects substantially similar to the services requested in this RFP within the last seven (7) years?

Experience on at least one (1) Design-Build project constructed for government clients?

5.

INSURANCE & CLAIMS HISTORY

Is your firm free from any court judgments, pending litigation, arbitration and final agency decisions filed within the last seven (7) years in a construction related matter in which the contractor, or any officer, is or was party?

[ ] No (Explain)

Has your firm during the past seven (7) years been free of a determination by a court of competent jurisdiction that it filed a false claim with any federal, state, or local government entity?

Does your firm have the ability to provide the required insurance (Professional Liability at $1M per occurrence and $5M in the aggregate)?

The undersigned certifies that all of the Qualification information submitted with this form is true and correct.

Firm Name

Signature

Address of Firm

E-mail Address

City, State, Zip Code

Telephone

Respondents are reminded to include a copy of each requested Team Member’s Statement of Qualifications with this Qualification Document.

APPENDICES INCLUDED:

(Please check all appendices included in this Submittal)

A Project Experience

B Resumes of Key Project Personnel

--------------------------------- END OF QUALIFICATION STATEMENT -------------------------------

APPENDIX A

COMPLETE ONE FORM FOR EACH PROJECT LISTED ON THE QUESTIONNAIRE

PROJECT DESCRIPTION

Project Type: ______________________________ Contact Title:

Project Name: _________________

Contact Name:

Project Location:________________________________ Land Uses:__________________________________ Owner:

Contact Phone No:

Current Owner (if other than Developer)______________ Date of Sale:_________________________________

DESIGN PROFESSIONAL

Phone Number:

Contact:

Title:

Gross Building Area (Sq Ft):

[ ] New [ ] Addition [ ] Renovation

Project Start Date:

Completion Date:

Construction Cost: $

Original Contract Duration (days)

Final Contract Amount

Final Contract Duration (days)

With all Change Orders: $

With All Time Extensions:

PROJECT EXECUTION

Were Liquidated Damages Assed on this Project? [ ] No [ ] Yes days _____ $

Percentage of Work Subcontracted:

Contract Type: [ ] Competitive Bid Lump Sum

[ ] Negotiated Lump Sum

A/E services executed:

[ ] Guaranteed Maximum Price

[ ] Design/Build

[ ] Other (Describe Below)

Mechanical

Electrical

Plumbing

Concrete

Fire

Protection

CUSTOMER SATISFACTION

How was this measured? [ ] Customer Survey Attached [ ] Yes [ ] No [ ] other (describe)

APPENDIX B

REFERENCE: 2 Resumes.

ATTACH ONE (1) PAGE RESUMES OF EACH OF THE PROPOSED KEY STAFF

1.0 EDUCATION

High School, College, Trade Schools, Trade Seminars, Trade/Management Specialized Courses, etc.

2.0 RELATED EXPERIENCE

Related experience should include the Position Title, Duties and Responsibilities, Dates of the Engagement, Major Accomplishments, Key Service Deliverables/Outcomes provided, and Number of Personnel Supervised.

3.0 PROJECT EXPERIENCE

Identify project experience. Include the Project Title and Location, and Reference Contact Information.

4.0 Other information that demonstrates the individual’s strengths for this project.

5.0 Project Professionals and Project Owner References may be included.

FIRM

POSITION

NAME

FIRM

FIRM

WIRE DIAGRAM SHOULD INCLUDE THE ENTIRE PROJECT TEAM, SUBCONTRACTOR KEY PERSONNEL AND SUPERVISION

General Contractor Statement of Qualifications

Rev 6/7/13 Federal Bureau of Investigation MACC RFP